Psoriatic Arthritis
You may have psoriasis and recently developed pain in your joints. You may be wondering if you have psoriatic arthritis. How can you tell? There is no single test that will definitively tell anyone if you have psoriatic arthritis, but there are a number of clues that clinicians can use to confirm or deny that diagnosis.
About 14% of people with psoriatic arthritis will develop the arthritis before ever seeing a skin lesion. The vast majority of cases happen well after the appearance of skin lesions. Usually, arthritis will happen about 11 years after the appearance of the skin lesions.
What Does Psoriatic Arthritis Affect?
Psoriatic arthritis usually affects the spinal joints but can also attack peripheral joints. The hand is a common location. All three joints of a digit might be affected. Psoriatic arthritis is also known to attack a single finger and leave the adjacent fingers alone. The soft tissue around a joint may become inflamed and swollen, too; in the finger, this appears as a ‘sausage’ digit. Such soft tissue swelling would be difficult to appreciate near the spine.
Many people with psoriatic arthritis feel the pain at the junction of tendons with bones. These attachment points are a favorite target of the disease.
Risk Factors
Specific features of psoriasis have a higher propensity to convert to psoriatic arthritis. Scalp lesions are correlated with arthritis. Also, those with nail pitting and psoriatic lesions of the intergluteal or perianal region are more prone to develop arthritis.
There is a hereditary component to psoriatic arthritis as well. The chances of developing psoriasis, psoriatic arthritis, or both if you have an afflicted relative are high. That being said, environmental factors play a large role as well. Recent trauma can cause psoriatic arthritis to start in almost 10% of cases. Viral illness may trigger the disease as well.
Being obese or having a high body mass index is associated with having a worse course of disease with psoriatic arthritis. This is possibly due to the inflammatory proteins produced by the fat cells. High BMI has been found to make the anti-psoriatic arthritic drugs work less well.
Signs & Symptoms
Certain serum markers are elevated more in patients with psoriatic arthritis than in those with psoriasis alone. CRP is one of these. Psoriasis and the arthritic manifestation are basically abnormal activations of the innate and adaptive immune systems. Chronic inflammation is a hallmark of the disease.
The clinical clues that are easy to remember to determine if you might have psoriatic arthritis are as follows:
- Joint stiffness that lasts more than 30-45 minutes in the morning
- Joint stiffness that lasts more than 30-45 minutes after periods of inactivity (such as driving, working at a desk)
- Joint swelling
- Sausage digits
- Tendonitis at tendon attachment points
- Nail lesions
- Usually an asymmetric presentation of joint pain
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If you believe that you may have this disease and would like a comprehensive evaluation and treatment plan, please visit us at Warner Orthopedics and Wellness!
